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Who decides how much doctors get paid?

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The majority of doctors work in the NHS and the pay of those on national agreements is reviewed annually by the independent Doctors' and Dentists' Review Body (DDRB). The DDRB makes recommendations to the following parties across the United Kingdom:

  • the Prime Minister
  • the Secretary of State for Health
  • the First Minister and the Cabinet Secretary for Health and Wellbeing of the Scottish Parliament
  • the First Minister and the Minister for Health and Social Services in the Welsh Assembly government
  • the First Minister, Deputy First Minister and Minister for Health, Social Services and Public Safety of the Northern Ireland executive 

Other doctors can be impacted by the DDRB recommendations, such as those in the UK Armed Forces, where pay in the Services is based on an analogue of their NHS equivalents. 

Find out more below.


  • NHS doctors

    In making its recommendations, the DDRB takes account of the following:

    • The need to recruit, retain and motivate doctors;
    • Regional/local variations in labour markets and their effects on the recruitment and retention of doctors and dentists;
    • The funds available to the health departments as set out in the Government’s Departmental Expenditure Limits;
    • The Government’s inflation target;
    • The overall strategy that the NHS should place patients at the heart of all it does and the mechanisms by which that is to be achieved.
    • >DDRB recommendations are not legally binding.  Governments can and have chosen not to implement recommendations in full, or in some cases, at all.  This might by reducing or ignoring a recommended increase for parts of the profession, or by staging the award to reduce real terms costs and therefore the value of any increase for doctors.

    As health is devolved from Westminster, there is the potential for differences in approach to the DDRB to emerge from individual Governments. For example, the Scottish Government elected to implement in full recommendations for a 1% uplift to the pay of employed doctors in 2014/15, but this was not implemented elsewhere. Recently, we have seen the standing terms of reference for DDRB restricted unilaterally by the UK Government which requested any recommendations be limited to 1% per year from 2016/17.

    You can read the BMA’s response in its latest evidence to DDRB here.

    The BMA continues to place importance in the Review Body as a way of doctors' pay being independently reviewed for the whole of the UK. 

    It is important to have centrally determined medical pay. It is consistent with the principles of the NHS that there should be an appropriate spread of doctors both geographically and by specialty - locally negotiated pay would undermine this important benefit to patient care. 


    Giving evidence to the Review Body

    The health departments, NHS Employers, NHS England, Health Education England and the BMA (on behalf of the profession) send written evidence to the DDRB each September. This is followed by oral evidence in December. The British Medical Association publishes its evidence on its website. 

    The BMA has a Review Body Evidence Committee which gives oversight to our written evidence. It is made up of representatives from each of the major groups of practising NHS doctors and takes expert input from BMA Staff.

    The DDRB reports to the Prime Minister sometime in the new year and the report is made public, with the government's decision, a few weeks later, for implementation on the following 1 April.

    The Review Body makes recommendations on the salaries of:

    • Consultants
    • Staff grades/Specialty doctors/Associate specialists
    • Doctors in training
    • Doctors in public health medicine and community health
    • General practitioners (independent contractors, salaried and trainees)
    • Ophthalmic medical practitioners

    The DDRB has also recommended the rates for clinical awards for hospital and public health medicine consultants.

  • GPs as independent contractors

    The majority of general practitioners are self-employed independent contractors. Since 2004 the general medical services (GMS) covers all independent contractors who have not opted to become a personal medical services (PMS) practice (known as Section 17C provider in Scotland). Approximately 60% of practices are on GMS contracts. GP practices, rather than individual GPs, contract with the primary care organisation (PCO) to provide general medical services.

    This contract (and thus practices) is funded via a number of different streams:

    • the global sum (the sum of money per patient)
    • the Quality and Outcomes Framework
    • minimum practice income guarantee (MPIG) 
    • enhanced services (e.g. identifying dementia)
    • IT
    • premises 
    • seniority payments
    • dispensing for dispensing practices. 

    Practices' entitlements to this funding are detailed in the Statement of Financial Entitlements. GPs' earnings are then determined by the practice's own business arrangement, whether this be as a single-handed practitioner, a partnership, or a company limited by shares.

    The level of funding and the level of entitlements to practices are negotiated nationally.


    Salaried GPs

    GPs can also work as salaried employees. Their terms and condition and salary are negotiated between the GP and the employer. In recent years, DDRB have tended to consider salaried GPs as comparable to employed doctors when recommending any uplift to their pay.  

    A salaried GP may be employed by a GP practice (GMS, PMS or Section 17C), by a primary care organisation or a private provider commissioned by the primary care organisation to provide primary medical services.

    The BMA provide a model contract for salaried GPs containing minimum terms and conditions of service, and salary range, updated annually by the DDRB, which we recommend should apply.

    In Wales, there is a separately negotiated salaried GP contract for those GPs employed directly by the GMS practice and the local health board.


    Personal medical services (PMS) and Section 17C schemes

    Personal medical services and Section 17C agreements are local alternatives to the national general medical services contracts. Originally a pilot project, PMS and Section 17C agreements became permanent on 1 April 2004 and terms of service are now governed by overarching regulations. 

    Although the contract budget remains locally negotiated between contractor and PCO, and the various elements of that budget are not nationally protected as in GMS. PMS and Section 17C agreements are becoming increasingly similar to GMS. PMS contractors have equal access to many of the new sources of income negotiated under the new GMS contract, such as the Quality and Outcomes Framework.


    GP trainees

    GP trainees' pay is currently calculated on their basic salary in their last junior hospital or consultant post, plus a supplement of 45 per cent. This is reviewed annually by the DDRB.


    Doctors' retainer and flexible careers scheme

    The GP retainer and flexible careers schemes are designed to ensure that doctors who can only undertake a small amount of paid professional work may keep in touch with general practice, retain their skills and progress their careers, with a view to returning to NHS general practice in the future.

    The schemes combine a service commitment with an educational component.

    These doctors are classed as salaried GPs, and therefore, the agreed minimum terms and conditions of service and salary range for salaried GPs apply to these doctors when employed by a GMS practice or primary care organisation, if this employment started on or after 1 April 2004. The BMA recommends the same for salaried GPs at PMS practices or private providers.

  • Clinical excellence awards and discretionary points

    Throughout the UK there is a system of clinical awards to which consultants (and for some awards SAS doctors) may be eligible. In England and Northern Ireland these are known as Clinical Excellence Awards (CEAs), previously known as discretionary points and distinction awards. In Wales, discretionary points were replaced by commitment awards, awarded at 3-yearly intervals for eligible consultants. The discretionary points system continues in Scotland. The type, rate and value of these awards varies by UK country with different awarding authorities. The value of these awards is subject to review by the DDRB.

    Doctors who are still on the discretionary point and distinction award system keep their points and awards until they successfully apply for a CEA. Discretionary points and distinction awards also continue to be up-rated annually by the DDRB (when up-rating happens).


    CEAs (England and Northern Ireland)

    There are 12 levels of award.  Levels 1 to 8 are awarded by local awards committees (LACs).  Levels 10 to 12 are awarded by the National Advisory Committee on Clinical Excellence Awards or the Northern Ireland Committee on Clinical Excellence Awards. In England, level 9 may be awarded by either the ACCEA or the local committees - this will depend on the type of achievement being recognised. In Northern Ireland, level 9 is awarded by the local committee.


    Commitment awards (Wales)

    There are eight awards with an equal value. These are awarded at 3-yearly intervals. Consultants can also to apply for national clinical excellence awards as in England and Northern Ireland.


    Discretionary points and distinction awards (Scotland)

    There are three types of distinction award: A+, A and B. 

    The Scottish Advisory Committee on Distinction Awards (SACDA) decides which individual medical and dental consultants in the NHS in Scotland should get distinction awards for outstanding professional work. All consultants who have reached the maximum of the old consultant contract salary scale, and all consultants who have reached point 5 of the pay point scale for the new consultant contract, are eligible for consideration for the award of discretionary points (DP) (unless they hold a distinction award). These are awarded by local NHS employers. 

    The DP scale has eight points of equal value. Local negotiating committees (LNCs) are responsible for agreeing the discretionary points process with local employers.  Associate specialists and staff doctors on the 1997 contract and national terms and conditions in all specialties and in full and part-time posts are equally eligible for optional and discretionary points once they have reached the top of their automatic incremental pay scale. 

    There are 6 optional and discretionary points on the top of each pay scale, and points are paid in full to whole timers, 10/11ths to maximum part timers and pro-rata to part timers.


    Banding supplements

    Junior hospital doctors are currently paid a banding supplement according to their contract, which can be a full, partial or 24 hour partial shift, an on-call rota or a hybrid. 


    London weighting

    Since 2004 London weighting has been included in the remit of the DDRB and it now recommends the amount. London weighting has not been updated since 2005 and the BMA has argued than an increase is overdue and merited given the large rise in cost of living in the capital.

  • Medical academic and research staff

    Dentists Review Body (DDRB). However, the Review Body can have an influence on the pay of some groups of medical academics and does concern itself about the recruitment and retention of medical academics.

    View the pay circulars


    Clinical academic staff

    Clinical academic staff are those medical and dental academics with an honorary NHS contract. There is a long-standing commitment by the employers and the UK government to pay parity between the members of this group of staff and their equivalents in the NHS.

    Pay scales have been agreed with the university employers that reflect those in the NHS and it has been agreed that the DDRB award should be translated pretty much automatically.

    The implementation of any fundamental changes to NHS pay scales still have to be agreed by negotiation involving the BMA on behalf of medical academics, the Universities and Colleges Employers Association (UCEA) on behalf of the employers, along with the British Dental Association and the University and College Union (UCU).


    Non-clinical medical academic staff

    Medical academics without a clinical commitment in the NHS, and thus without an honorary NHS contract, are paid on the standard pay scales for academic staff. These are negotiated by the University and College Union (UCU). These pay rates are generally much lower than those of their clinical colleagues.

    The BMA does not have negotiating rights regarding the pay of this group of doctors but has engaged with the university employers on issues such as the gender pay gap, career progression, pensions and appraisal and revalidation.


    Medical Research Council staff

    The pay of Medical Research Council (MRC) staff is broadly in line with that of clinical academic staff or non-clinical staff, as appropriate – the MRC has recently joined UCEA. The BMA represents medical staff employed by the MRC and is represented at meetings of the joint trades unions.

  • Civil service medical officers

    The pay of full-time civil service medical officers is negotiated annually by the trade union Prospect.

    Pay and terms and conditions of service are now negotiated with the individual employing departments and agencies, for example, Ministry of Defence, Department for Work and Pensions, Department of Health, Veterans Agency, Prison Service and Driver and Vehicle Licensing Agency.

    As a consequence of delegated pay in the civil service, there is no longer any link between pay and terms of conditions of service for medical officers in different organisations within the civil service. However, many of the pay systems do include an element of performance related pay (PRP).


    Prison medical officers (full-time)

    Full-time prison medical officers' pay is the same as that of civil service medical officers but they also receive an environmental supplement.



    Some fees such as for family planning in hospitals are included in the DDRB remit, others are negotiated by the BMA's professional fees committee (PFC) which generally seeks increases in line with GP remuneration. The PFC also reviews in March each year its suggested fees for part-time work undertaken by a patient's own GP or other attending doctor which is not governed by statute or negotiated agreements.

  • Other doctors

    The Doctors' and Dentists' Review Body (DDRB) award is the prelude to pay rounds in other sectors, including certain fees for part-time medical services outside a doctor's main contract.


    Armed forces doctors

    The pay of doctors and dentists in the Defence Medical Services is determined by the Armed Forces Pay Review Body (AFBRB). This takes account both of its own award for armed forces personnel and the DDRB. Following the Medical Manning and Retention Review completed in 2002, armed forces pay is based on an analogue with NHS consultant pay. This is adjusted to allow for the difference in the Armed Forces and NHS pension schemes. To compensate for the 'turbulence' of service life, armed forces salaries are uplifted by what is known as the 'x' factor.

    The DMS consultant pay scale incorporates the discretionary points of the NHS consultant pay scale. The DMS has also established a distinction awards scheme modelled on that for the NHS. However, unlike their NHS equivalents, the awards are, unfortunately, not currently pensionable. DMS GMPs are also entitled to sustained quality payments along similar lines to their NHS colleagues and those that are trainers also receive trainer pay, but currently at a lower rate than is paid in the NHS. Neither of these payments is currently superannuable.


    Civilian medical practitioners

    The terms of service for civilian medical practitioners are those of the Civil Service, but CMPs' pay is under a separate analogue established by the MoD. The link used to be to the intended average net income of GPs in the NHS, from which a pay scale had been developed based on the seniority payments made to NHS GPs. However, since the introduction of the new general medical services contract there is no longer an equivalent IANI figure. Discussions are continuing on a new, appropriate analogue, one proposal being the salary range for salaried NHS GPs. Pay is superannuable under the non-contributory Civil Service scheme. Those practitioners involved in GP training receive the trainer allowance at the rate payable to armed forces doctors.

    There are a small number of civilian consultant posts which are paid at the same rate as the NHS, though without access to discretionary points or distinction awards. Some (mostly hospital) posts are not established and are offered for a fixed period only, usually three years. These non-established posts are known as CILOMs (civilian in lieu of military). Discussions are continuing on the implementation of the new NHS consultant contract for civilian consultants employed by the MoD. There are also opportunities for locum work with the MoD in both the secondary and primary care sectors.


    Occupational health

    Through its occupational health committee the BMA updates its own guidance on rates for occupational physicians from 1 April each year in line with the award to NHS hospital doctors.

    Further reading: The occupational physician - BMA handbook (its supplement gives rates of pay)


    Forensic physicians

    Forensic physicians are not salaried - most work on a part-time basis outside their main contract. Fees are agreed nationally by the BMA through the Joint Negotiating Committee for Forensic Medical Examiners and increases are based on those for NHS doctors, but fees must be agreed each year. The fees paid are a mixture of retainer, sessional and item of service fees.

    Read more about fees for Police work (includes rates of pay).


    Pharmaceutical physicians

    Pay will vary widely depending on level of seniority and size of company. However, in general terms the pay equates to different points on the NHS hospital consultant scale


    Prison medical officers (part-time)

    The salary of part-time prison medical officers is agreed between the BMA's civil and public services committee and the Home Office. It is linked to the mid-point of the NHS hospital practitioner grade and therefore increases each year following the DDRB report. (For full-time prison medical officers.)

    The Prison Service also employs doctors, usually consultants, on a sessional basis. These 'visiting person medical officers' are paid at rates issued by the Prison Service following discussions with the professional fees committee.



    Some fees such as for family planning in hospitals are included in the DDRB remit, others are negotiated by the BMA's professional fees committee (PFC) which generally seeks increases in line with GP remuneration. The PFC also reviews in March each year its suggested fees for part-time work undertaken by a patient's own GP or other attending doctor which is not governed by statute or negotiated agreements.

    Find out about the work of our Professional fees committee

  • Related guidance on fees

    We have extensive guidance and information about fees for part-time medical services which cover the wide variety of work available outside a doctor's main contract.

    Check our Fees section